Danger signs or symptoms in chronic rhinosinusitis (CRS), potential causes, and unrelated disorders to consider

Danger signs or symptoms	Potential complications of CRS that could cause the sign/symptom	Unrelated disorders that could cause the sign/symptom
Severe headache	Meningitis	Meningitis Headaches (migraine, tension, cluster) Stroke Cerebral hemorrhage Carotid artery dissection Dural sinus thrombosis Giant cell arteritis Acute angle-closure glaucoma Hypertensive emergency Idiopathic intracranial hypertension Medication side effects^* Mucoceles
Meningeal signs	Meningitis Brain abscess	Meningitis Brain abscess Encephalitis Brain tumor Stroke Subdural hematoma Subarachnoid hemorrhage
Focal neurologic signs	Meningitis Compression from sinus mucocele	Meningitis Stroke Tumor Trauma Encephalitis Medication side effects
Ophthalmoplegia	Orbital cellulitis	Orbital cellulitis Myasthenia gravis Graves' disease Multiple sclerosis Stroke Cavernous sinus thrombosis Skull base tumor/infection
Frontal or periorbital edema	Periorbital cellulitis	Periorbital cellulitis Angioedema Frontal sinus erosion (Pott's puffy tumor)^¶ Mucocele formation Graves' disease Malignancy Contact dermatitis
Proptosis	Orbital cellulitis Sinus mucocele with orbit extension Rhino-orbital mucormycosis (rare)	Graves' disease Autoimmune/inflammatory disorders Malignancy Vascular abnormalities (cavernous sinus thrombosis)
Double or reduced vision	Orbital cellulitis Periorbital abscess Orbital abscess Sinus mucocele with orbit extension	Orbital disorder Graves' disease Cranial nerve palsy Neurologic disorder Cavernous sinus thrombosis
Significant/recurrent epistaxis	Medication (side effects of high-dose intranasal steroids)	Vascular abnormality (Kiesselbach plexus) Thrombocytopenia Hepatic failure Malignancy (leukemia, intranasal tumors) Hereditary hemorrhagic telangiectasias

The table lists danger signs/symptoms, complications of CRS that may cause those signs/symptoms, and separate disorders that can also cause those signs/symptoms.

CRS: chronic rhinosinusitis.

* Examples include calcium channel blockers (higher doses), oral contraceptives, sildenafil, and nitroglycerin.

¶ Pott's puffy tumor is a rare complication of acute rhinosinusitis or acute on chronic rhinosinusitis.

Reference:

Fokkens WJ, Lund VJ, Hopkins C, et al. European position paper on rhinosinusitis and nasal polyps 2020. Rhinology 2020; 58:1.

Graphic 148754 Version 1.0

خرید پکیج

Danger signs or symptoms in chronic rhinosinusitis (CRS), potential causes, and unrelated disorders to consider